Individual
DAN LEE FORTENBACHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2908 DIVISION STREET, ST JOSEPH, MI 49085
(269) 983-3309
(269) 983-0846
Mailing address
2908 DIVISION STREET, ST JOSEPH, MI 49085
(269) 983-3309
(269) 983-0846
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
4901002693
MI
152WV0400X
Vision Therapy Optometrist
Primary
4901002693
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900A165280
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
Enumeration date
02/27/2007
Last updated
05/20/2015
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